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Friday, February 10, 2012

Friday Flip-Through

So, while I'm not pregnant, this doesn't mean I haven't been reading the crap out of blogs etc for about two years. (I'm an expert!) (Har.) This week I started in on Jennifier Block'sPushed: The Painful Truth About Childbirth and Modern Maternity Care. To summarize, it's basically a research study on managed maternity care and how it is failing women and pushing them to have unnecessary major medical procedures. (I always think this is common knowledge, but then talk to people outside the Internet and they look at me with boggly eyes. This happens in general between me and Not On The Internet people. Get on the Internet, people! You mean there are people out there who do not obsessively check their Google Reader feed all day??) I'll never watch Teen Mom the same way again with all the induce-induce-induce-pit-pit-pit etc.

Some highlights (note: I have 33 pages of highlights alone in my Kindle*):

Even though the United States has the most intense and widespread medical management of birth -- 99% of women give birth in a hospital -- we rank near the bottom among industrialized countries in maternal and infant mortality. In spite of our vigilance, preterm births are on the rise, cerebral palsy -- thought to be caused by fetal distress -- rates have remained stagnant, and in 2002, infant mortality rose for the first time since 1958. [...] Although we are superior in saving the lives of infants born severely premature, women are 70% more likely to die in childbirth in the United States than in Europe. Black women are four times more likely to die than white women. In the countries with the best maternal and infant outcomes -- the Netherlands, Sweden, and Denmark -- women and babies benefit from lifelong universal healthcare, but that care is markedly different: obstetricians attend only high-risk pregnancies. The vast majority of laboring women get individual support from a midwife, are free to move about and birth in whatever position feels best, and are rarely induced, anesthetized, or cut. These countries have between a 14% and an 18% cesarean rate, and in the Netherlands some 20% to 30% of births happen at home with virtually no medical intervention at all. (pg. xv, Kindle edition)

A 2004 publication called What Every Pregnant Woman Needs to Know About Cesarean Section points out, "As cesarean rates continue to rise, it may be harder to reach a goal of avoiding a cesarean than [of] having one." (pg. xvi)

The most recent study, of 5000 low-risk women who had planned home births, found home to be just as safe as the hospital. Only 3.7% of these women underwent cesareans, 2.7% received Pitocin, and 2.1% got episiotomies. Low-risk women giving birth in hospitals have far higher rates of intervention and surgery, yet the same number of neonatal deaths." (pg. xvii)

"A woman is four times more likely to die having a cesarean section than a vaginal birth." (pg. xix)

"Most practicing obstetricians have never witnessed an unplugged birth that wasn't an accident." (pg. xix)

"Once you hit the hospital, a time clock begins ticking. I only have so many beds available," Lethbridge explains. Physicians would routinely rupture waters artificially and order Pitocin to achieve a birth by day's end. [...] "In all honestly, you're probably better off at home," says Lethbridge. "You'll be more relaxed, you can eat, you can shower, you can walk around." (pg. 4)

"Once you're admitted [to the hospital], my feeling is that we should be advancing our cause" (pg. 6)

In Highlands County, Florida, Tracy Lethbridge says induction is "the norm, not the exception." (pg. 6)

"It's convenient for the physician mainly, but convenience also for patients," says Simpson. [...] Inducing tends to create longer, more painful labors in general, and it ups a woman's chance of a C-section by two or three times." (pg. 14)

In 2005, nearly all women giving birth in a U.S. hospital had the sensor bands strapped around their bellies -- the Mothers survey counted 93%. Most respondents to the survey were in fact bound several times over: 83% had an IV line in their arm, 56% had a urine catheter, and 76% had epidural or spinal anesthesia. It is unclear which gets attached first, but the primary reason women gave for being prostrate was not that they were numb but that they "were connected to things." Michelle McSweeney in New York City had originally wanted an unmedicated birth but gave in to an epidural because "I couldn't get up anyway," she recalls. "I've got these belts around my gigantic stomach, I've got a catheter, I've got a thing on my finger, I've got an IV in my arm. I felt like a science project." (pg. 35)

The strongest predictor of surgical delivery is not health status or age, but where and with whom a woman gets care. [...] One 2006 study concluded that "a geographic variation in the number of C-sections performed is driven by mostly nonmedical factors, such as provider density and local medical malpractice issues, and is mostly unrelated to the mother's medical condition." (pg. 58-59).

[On VBAC (Vaginal Birth After Cesarean):] The risk-benefit analysis of VBAC versus repeat cesarean breaks down something like this: If you are a woman attempting a VBAC, you have around a 75% chance of delivering vaginally and avoiding another major surgery and at least a 99.5% chance of not suffering uterine rupture. If you choose a repeat cesarean you have a 99.8% chance of not suffering a uterine rupture (it can still happen) and a 100% chance of having another major surgery, with all the risks and drawbacks that entails. these include longer hospital stay; longer and more painful recovery; higher risk of infection, organ damage, adhesions, hemorrhage, embolism, hysterectomy; more blood loss; higher chance of rehospitalization; higher chance of a complication with the next pregnancy; less initial contact with the baby; less success breastfeeding; higher risk of respiratory problems for the baby; and twice the risk of the most catastrophic complication of all: maternal death. (pg. 90)

L didn't think she was asking for much: to be able to move around in labor, birth in a comfortable position, and keep her baby close immediately following delivery. With no birthing centers nearby and home birth prohibitive at $2000 out of pocket -- even after partial coverage from her health insurance -- she initially settled on giving birth at a hospital with a nurse-midwife. "She bent over backwards for me," says L. "She arranged with the head nurse that the baby would stay with me -- hospital policy was that he would be taken away for a battery of tests. But then she and the midwife came to an impasse: the fetal monitor. "I was really upset, I thought why is this so damn hard -- to have a baby the way you want to have a baby?" L had done research and knew monitoring would mean a bedridden labor and an increased chance of surgery. "To have to lie on your back during labor was anathema to me," she says. "I was like, 'This is my body and my birth, why am I agreeing to this if there's no demonstrated medical need?" (pg. 106)

Prominent physicians continue to present cesarean delivery as nearly risk-free. (pg. 121) [...] The cesarean is a landmark achievement of modern medicine, a life -- and health -- saving procedure. Still, it is major surgery. The CDC considers all abdominal surgery a trauma to the body, a morbidity. A deep wound is created, the uterus is entered, and the mother loses blood. Her body takes a beating. One woman who had a planned repeat cesarean told me, "It was like I was in a car accident and had a baby at the same time." (pg. 123) [...] "The data is absolutely unambiguous," he says. "The enhanced risks for placenta previa, accreta, percreta, ectopic pregnancy, and infertility go up after the first cesarean section. There's a huge amount of morbidity associated with subsequent births. And they [Mary Hannah's study/researchers] chose simply not to look at it." (pg. 127)

etc etc etc

And yet women are pushed to do this. Pressured and pushed like crazy by their doctors! And health insurance will only cover the norm (upon initial research, my only "offbeat" in-network option is the nurse midwife dept. at VCU teaching hospital -- I need to call them to figure out if I even have any other option that doesn't involve huge out-of-pocket expenses) (and then I have to weigh my chances of ending up with a major surgery I do.not.want and all the trappings of the rollercoaster that seems to be hospital maternity care...and figure out if simply having a crazy out of pocket expense is still better for my health).

This is egregious. I knew that modern maternity care was a little off, judging by the blogosphere and basic stuff I read, but damn. The book is well documented (references are everywhere, although I didn't include numbers in this post because that would take a lot of time, because there were a lot of references), and should be on every maternity book display ever.

1 comment:

Thanks for sharing your discoveries! I'm nowhere near ready to have children... but this is definitely a topic I'm looking into when that time comes. Women have been having children since the world began, and while modern medicine might make it safer in some ways (though while, as you pointed out, greatly increasing other risks), the idea that it'll end in catastrophe if its not done in a controlled hospital setting is purely preposterous. Our bodies were designed for this - give us a little credit and faith.